Lecture 19 Muscle and Nerve Disease Flashcards Preview

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Flashcards in Lecture 19 Muscle and Nerve Disease Deck (26)
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1
Q

Symptoms of muscle disease

A

• Weakness of skeletal muscle
– Short of breath (respiratory muscles)
– Poor swallow / aspiration (bulbar muscles)
• Cardiomyopathy
• Cramp, pain, stiffness, myoglobinuria
(Babies: poor suck / feeding / failure to thrive / floppy)

2
Q

Signs of muscle disease

A
  • Wasting / hypertrophy
  • Normal or reduced tone and reflexes
  • Motor weakness…NOT sensory
3
Q

Muscle Disease Investigation

A
•	History and examination
•	Creatine Kinase (CK)
•	EMG- Electromyography (EMG) 
Muscle bx
Genetic Testing
4
Q

What are the groups of muscle disease classification

A

Congenital/genetic

Acquired

5
Q

Name Congenital/Genetic muscle diseases

A

Muscular dystrophies
Congenital Myopathies
Channelopathis
Enzyme/mitochondira

6
Q

Name Acquired Muscle Diseases

A

– Metabolic (Ca2+, K+)
– Endocrine (thyroid, adrenal, vit D)
– Inflammatory muscle disease
– Iatrogenic: medication (steroids / statins)

7
Q

Describe Channelopathies

A
  • disorders of Ca2+, Na+, K+ and Cl- channels
  • often paroxysmal symptoms e.g. periodic paralysis / myotonia
  • partially treatable
8
Q

Early exercise induced metabolic myopathy

A

Disorders of carbohydrate metabolism

Mitochondrial problems- partially treatable

9
Q

Late exercise induced metabolic myopathy

A

Disorders of lipid metabolism

Mitochondrial problems- partially treatable

10
Q

Name 2 inflammatory muscle diseases

A

Polymyositis

Dermatomyositis

11
Q

What are the symptoms of Inflammatory muscle disease

A
  • Acute or subacute, painful, weak muscles

* Characteristic rash of DM

12
Q

Investigations for inflammatory muscle disease

A

• High CK, autoantibodies, tumour screen (esp DM)
• EMG & biopsy
– Polymyositis: CD8 cells
– Dermato: humeral-mediated, B cells and CD4 cells

13
Q

Whats the treatment to inflammatory muscle disease

A

Immunosuppression

14
Q

What is Myasthenia Gravis

A

Disorder of neuromuscular junction

15
Q

Clinical presentation of Myasthenia Gravis

A
Fatiguable weakness
Ptosis
Diplopia
Bulba (chew, swallow, talk)
Breathinh
16
Q

Investigations for disorders of the neuromuscular junction

A
  • AChR, Anti MuSK antibodies
  • Neurophysiology (Repetitive stimulation, Jitter)
  • CT chest (thymoma)
17
Q

Treatment of Myasthenia Gravis

A

• Symptomatic
– Acetylcholinesterase inhibitor (pyridostigmine)
• Immunosuppression
– Prednisolone
– Steroid saving agent (e.g. azathioprine)
• Immunoglobulin / plasma exchange
• Thymectomy

18
Q

What does the peripheral nerve consist of

A
•	Sensory axons
–	Small fibres (pain + temperature)
–	Large fibres (joint position sense + vibration)
•	Motor axons
•	Autonomic axons
•	Nerve sheath (myelin)
19
Q

Causes of generalised peripheral neuropathy

A
–	Hereditary
–	Metabolic: diabetes, alcohol, renal failure, B12
–	Toxic: drugs
–	Infectious: Lyme, HIV, leprosy
–	Malignancy: paraneoplastic
–	Inflammatory demyelinating:
Acute = Guillain Barre syndrome
Chronic = chronic inflammatory demyelinating polyneuropathy
20
Q

Nerve root disease symptoms

A

– Myotomal wasting and weakness
– Reflex change
– Dermatomal sensory change

21
Q

Individual nerve disease symptoms

A

– Wasting and weakness of innervated muscle

– Specific sensory change

22
Q

Symptoms of generalised neuropathy

A

– Sensory and motor symptoms, usually starting distally and moving proximally

23
Q

Investigations of Nerve disease

A
  • Blood tests
  • Genetic analysis
  • Nerve Conduction Studies
  • Lumbar puncture (CSF analysis)
  • Nerve biopsy (nb sensory nerve)
24
Q

Treatment of nerve problem

A

• Treat the cause eg stop drug, surgery, immunoglob

25
Q

Diagnosis of Motor Neuron Disease

A
  • Unique combination of UMN + LMN signs with no sensory signs
  • EMG
26
Q

Treatment of Motor Neuron Disease

A

• Supportive
– PEG feed, non invasive ventilation, physio, OT, SALT, care
• Riluzole
• Anticipatory / palliative care

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